Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastic disease in axillary lymph nodes of breast cancer patients

Am Surg. 1998 Jun;64(6):539-43; discussion 543-4.

Abstract

Pathologic examination of axillary lymph nodes (ALNs) may miss micrometastases in 30 per cent of breast cancer patients. We have developed a multimarker reverse transcriptase-polymerase chain reaction (RT-PCR)-based screening method that detects histopathologically positive ALNs with a 5 per cent false-negative rate. The purpose of this study was to compare this RT-PCR methodology with histopathology with regard to sensitivity and cost. Pathologically negative ALNs from 35 breast cancer patients were re-evaluated by a single pathologist in a blinded fashion using serial sectioning with immunohistochemical staining. Histopathologic results were then compared with those of RT-PCR. Cost analysis was performed based on standard charges for these methods. RT-PCR identified micrometastases in 14 of 35 pathologically negative nodes. Serial sectioning and immunohistochemical staining identified micrometastases in two cases, with RT-PCR positive for one of these. The charge per specimen for performing routine histopathologic examination was $380, serial sectioning and immunohistochemical staining $787, and RT-PCR $125. RT-PCR appears to be more sensitive at detecting ALN micrometastasis than histopathologic examination even with serial sectioning and immunohistochemical staining. If micrometastatic breast cancer detected by RT-PCR proves to be clinically relevant, it could be a more effective screening methodology with significant cost savings as compared to currently available pathologic examinations.

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Biomarkers, Tumor / analysis
  • Biopsy / economics
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Breast Neoplasms, Male / pathology
  • Breast Neoplasms, Male / surgery
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Keratins / analysis
  • Lymph Node Excision
  • Lymph Nodes / pathology*
  • Male
  • Mastectomy, Modified Radical
  • Mastectomy, Segmental
  • Middle Aged
  • Neoplasm Staging
  • Polymerase Chain Reaction* / economics
  • Sensitivity and Specificity

Substances

  • Biomarkers, Tumor
  • Keratins